CHAPTER 3: Asking and formulating the right questions and finding useful resources in evidence-based pharmacy—2nd edition:

Guidelines for evidence synthesis reporting: medications

In the process of determining if a drug is valuable enough to be included in a hospital's pharmacotherapeutic repertoire many factors should be taken into account. In order to develop a guide, the methodology of different appraisal working groups and similar methodological documents published by Health Technology Assessment agencies have been taken into account. We recommend that reports are structured with the following headings: Medication/Description/Authorised indication; Description of the disease; Pathology reference treatment; Evaluation of efficacy and safety (Bibliographic search, Quality assessment, Efficacy and safety results); Assessment of ethical, organisational, social and legal aspects; Strengths and limitations of available evidence; Pharmacoeconomic evaluation; and Key points. This guide to evaluate technologies may be used as a tool in decision-making scenarios related to health innovation. It could be used by hospital pharmacists and by clinicians, health system professionals and public services advisors.

Medication adherence interventions and outcomes: an overview of systematic reviews

Objective

To present evidence for healthcare-provided medication adherence interventions on clinical, economic and humanistic outcomes among patients.

Methods

Literature search of systematic reviews in Medline, Embase and CINAHL (2007-2017), validation of quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses questionnaires and, finally, extraction, combination and tabulation of results for included studies.

Results

From eight systematic reviews with medium to high AMSTAR 2 score, 37 randomised controlled studies involving 28 600 participants were extracted. Patient education and counselling showed some positive effects on medication adherence. Patient education also showed some positive effects on morbidity, healthcare utilities and patient satisfaction. Counselling had some benefit on mortality and healthcare utilisation. Simplifying doses was shown to have some benefit on morbidity and patient satisfaction. Interventions delivered by pharmacists and nurses showed a better result in improving adherence and outcomes than interventions delivered by general practitioners.

Conclusions

Some interventions were found to have positive effect on adherence and outcomes, but no single strategy showed improvement in all settings. For future research patients should be screened for non-adherence to reveal both if they are non-adherent and type of non-adherence, as well as bigger sample sizes and longer duration of follow-up.